Changes in health related quality of life in patients with Parkinson's disease with and without posteroventral pallidotomy

Traditional clinical outcome measures for the treatment of Parkinson's disease (PD) have focused on motor function and activities of daily living. However, in the past decade there has been a new emphasis on the use of health related quality of life (HRQOL) measures for translating how a patient's response to treatment is experienced by the patient. The purpose of this study was to describe patient reported HRQOL in subjects who underwent Posteroventral pallidotomy (PVP) for the treatment of PD compared with a similar group of subjects who did not undergo surgery (non-PVP). A consecutive series of patients who underwent PVP (n = 52) was compared prospectively with a similar group of patients, who received adjustments to medications without surgery (n = 45). Severity of disease and self reported HRQOL were evaluated at two time periods. Time 1 data were collected within one week prior to surgery for the PVP group or when subjects received medication adjustments for the non-PVP group. Time 2 data were collected 4 months later. Results showed that the severity of disease improved from Time 1 to Time 2 for both groups. HRQOL improved significantly for the PVP group (p = 0.001) but not for the non-PVP group (p > 0.29). Changes in HRQOL were most strongly related to the improvement in severity of disease in the "off" state. The results of this study suggest that PVP is associated with significant improvements in clinical and patient reported outcomes four months following surgery compared with a similar group of patients who did not undergo surgery. Additionally, the results suggest that the difference in perceived outcome between the groups is due in part to the improvement in the levodopa "off" periods which occurred for the PVP group but not for the non-PVP group.